March 28, 2014
Nashville undertook some major health reforms in the late 1800s. Like other communities, we faced deadly epidemics of cholera, yellow fever, smallpox, and typhoid. Thanks to sanitation, clean water, and vaccines, these infections rarely occur in Nashville now.
The cause of tuberculosis (TB) was discovered in 1882, but it lingered as a leading cause of illness and death well into the 20th century. The burden of disease was high enough to prompt building of a State TB hospital in Inglewood in the mid-1950s; just as effective drug treatments were being developed that could cure TB.
The Inglewood TB hospital closed within 25 years, but TB did not disappear. It might surprise some people to learn that we still do have home-grown cases of TB here, but while its incidence has been declining, TB remains a threat to be taken seriously.
As a disease, TB typically affects the lungs, but can affect any part of the body. When a person with untreated TB disease of the lungs coughs, they can produce particles containing live TB bacteria that float in the air and can be inhaled by anyone sharing and indoor space with them. Inhaling TB bacteria can lead latent TB infection, wherein living TB bacteria remain present without causing symptoms for months, years, or decades, and can reactivate and cause disease at any time.
The most important way to control TB is to identify patients with active TB of the lungs and make sure they are cured. This stops the spread of the bacteria and prevents future cases. Treatment is not simple, and requires 6-12 or more months of treatment. If a patient isn’t treated correctly or doesn’t take all their medicine, then persistent disease and even drug resistance can occur. Further, we can prevent TB by identifying people with latent TB infection who can benefit from preventive treatment.
The costs and consequences of using unproven or inadequate treatments are high. For that reason, the Public Health Department plays a central role in the care and control of TB. Every case is reported to us, and our public health professionals take responsibility for helping every patient achieve a cure as well as testing people exposed to TB to identify latent infection and limit spread of the disease. This requires working across many languages, cultures, and social barriers to deliver accurate information and effective medical care. The results? Your TB team ensured cure of 100% of our cases the last two years, and Nashville’s TB rates have declined over the last 5 years and are now are the lowest rates ever recorded.
We are now in a new period of health reform. While there is plenty of disagreement about it, most people agree with the triple aims of improved patient experience, cost containment, and better community health outcomes. TB is an example of accountable care linked to better community health. While we would like to see TB eliminated, the disease remains a major killer worldwide, and as Nashville thrives by being connected to the rest of the world, we will need to maintain the ability to cure and control TB in an organized and accountable way.
William S. Paul, MD, MPH, FACP
Director, Metro Public Health Department